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Pharmacology > Module 6 > Flashcards

Module 6 Flashcards

1
Q

first line tx for alcohol withdrawal

A

Benzodiazepines

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1
Q

What do benzodiazepines end in?

A

-lam and -pam

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2
Q

Prototype for alcohol withdrawal is

A

Chlordiazepoxide

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3
Q

S/a effects of benzodiazepines

A

Sedation, depression, lethargy, disorientation, and delirium. Paradoxical rxns, lower HR and BP, urticaria, constipation, diarrhea, dry mouth, jaundice, changes in libido, blood dyscrasias

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4
Q

How are benzodiazepine doses determined?

A

Institution-specific protocol
Score pt
Seizure precautions

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5
Q

Evaluation for benzodiazepines

A

VS WNL, seizures decrease/improve, alcohol withdrawal S/S decrease

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6
Q

What is the antidote for too much benzodiazepines?

A

Flumazenil IV

(romazicon)

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7
Q

Alcohol use disorder

A

Disulfiram is used as tx
Maintenance of sobriety after initial detox
Adherence=poor
Tablet 125 mg-500 mg dailynon

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8
Q

Heroin withdrawal

A

Methadone
Slowly tapered
12 step program
Approved tx center
Naloxone for methadone OD

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9
Q

Sedatives- another name

A

Hypnotics

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10
Q

What are the two sedative drug classes?

A

Benzodiazepines and non-benzodiazepines (zolpidem )

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11
Q

What are the benzodiazepines drugs?

A

Lorazepam, alprazolam, diazepam, halazepam, oxazepam, clonazepam, midazolam

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12
Q

Benzodiazepines are used to treat

A

GAD and panic disorder

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13
Q

What route and time are benzodiazepines given?

A

IV and scheduled

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14
Q

Benzodiazepines are a pregnancy category

A

D

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15
Q

Contraindications for benzodiazepines

A

Glaucoma, sleep apnea, and respiratory depression

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16
Q

What do benzodiazepines enhance inhibitory effects of

A

GABA in the CNS

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17
Q

What routes can benzodiazepines be given?

A

IV and IM

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18
Q

Benzodiazepines have a block box warning for

A

Risk of serious a/e if given with opioids

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19
Q

Benzodiazepines are widely

A

Abused

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20
Q

adverse effects of benzodiazepines

A

Hangover, REM rebound, CNS and respiratory depression, anterograde amnesia, toxicity, paradoxical response, physical dependence, tolerance, withdrawal effects, hypersensitivity

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21
Q

Pt teaching for benzodiazepines

A

S/s CNS and respiratory depression
Avoid activities=alertness
Avoid CNS depressants
Report amnesia, paradoxical response,s/s withdrawal
Taper when d/cing
Take before bed, limit continuous use
Sleep hygiene
Avoid grapefruit juice

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22
Q

nursing considerations for benzodiazepines

A

Med reconciliation, VS and LOC, toxicity(gastric lavage, activated charcoal, saline cathartics), flumazenil, VS, airway, BP, crash cart, falls precautions, renal function

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23
Q

Nonbenzodiazepine drugs

A

Zolpidem, zaleplon, eszopiclone

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24
Q

Mechanism of action for non benzodiazepines

A

Enhances action of GABA in the CNS

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25
Q

Side and a/e for non benzodiazepines

A

Hangover, HA, dizziness, lethargy, anterograde amnesia, memory impairment, ataxia

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26
Q

Pt teaching for non benzodiazepines

A

Take at bedtime, avoid other CNS depressants, sleep hygiene, oral or SL, avoid activities=alertness, be careful with OTC meds, report hangovers

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27
Q

Benzodiazepines induce

A

Sleep(sedation)

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28
Q

Nonbenzodiazepines induce

A

Mild sedation

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29
Q

What are the anti epileptic drug classes?

A

Hydantoins, Benzodiazepines, succinimides, and misc.

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30
Q

Hydantoins are a pregnancy category

A

D

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31
Q

Benzodiazepines are a pregnancy category

A

D (most)

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32
Q

Carbamazepine is a pregnancy category

A

D

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33
Q

Valproic acid is a pregnancy category

A

D

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34
Q

Topiramate is a pregnancy category

A

D

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35
Q

Lamotrigine is a pregnancy category

A

C

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36
Q

Gabapentin is a pregnancy category

A

C

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37
Q

What drug did we talk about for Hydantoins

A

Phenytoin

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38
Q

What is phenytoin?

A

An anticonvulsant

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39
Q

Mechanism of action for phenytoin

A

inhibits sodium influx=decrease/prevents neural firing=raises seizure threshold

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40
Q

Phenytoin is ______ _________ ________ (90%)

A

Highly protein bound

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41
Q

Phenytoin is highly protein bound- _____%

A

90

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42
Q

Serum drug levels are affected easily for this drug

A

Phenytoin

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43
Q

What is the therapeutic drug level for phenytoin

A

10-20mcg/mL

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44
Q

Contraindications for phenytoin

A

Sinus bradycardia, SA block, 2nd and 3rd degree AV block, Adams-stokes syndrome, hypersensitivity

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45
Q

Phenytoin black box warning

A

Cardiac collapse. SI, raised BG levels

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46
Q

Side/adverse effects for phenytoin

A

CNS symptoms, nausea, gingival hyperplasia, blood dyscrasias, osteomalacia, stevens-Johnson syndrome, liver damage, cardiac collapse (IV), endocrine effects

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47
Q

Drug interactions for phenytoin

A

Anticoagulants and aspirin, sulfonamides and cimetidine, oral contraceptives

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48
Q

Pt teaching for phenytoin

A

Similar to other antiseizure meds, take calcium and vitamin D, avoid herbs and OTC meds, take at same time each day

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49
Q

Nursing interventions for phenytoin

A

Monitor serum drug level, mental and Neuro function assess, changes in seizure activity, CBC, BG(DM), give slowly IV, liver dysfunction-LFTs

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50
Q

A pt has been prescribed zolpidem for insomnia. Which of the following will the nurse include in the teaching SATA
A.The drug can be safely used for as long as 1 month
B.one of the most common side effects of the drug is HA
C. It should be taken 1 hour to 90 minutes before going to bed
D. This drug should only be used short term 7-10 days

A

B and D

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51
Q

Why should zolpidem be taken immediately?

A

Induces sleep rapidly

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52
Q

How long is zolpidem generally used?

A

7-10 days

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53
Q

What are the comon side/adverse effects of zolpidem?

A

HA, prolonged drowsiness, dizziness

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54
Q

A pt w/ insomnia says she no longer wants to take lorazepam due to AE. What is important info to teach the pt?
A.it will take 2 weeks for the drug to leave the system
B. Symptoms will only improve with med therapy
C.the drug should be tapered gradually to prevent severe withdrawal symptoms
D.d/cing the drug is unwise

A

C

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55
Q

How should withdrawal symptoms be prevented or benzodiazepines?

A

Tapered in dose and gradually discontinued

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56
Q

A pt took too many benzodiazepines and is experiencing toxicity. What med will the nurse plan to admin?

A

Flumazenil

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57
Q

What is the benzodiazepine toxicity antidote?

A

Flumazenil

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58
Q

A pt wishing to detox from heroin has been approved for methadone therapy. What should the nurse teach the pt?
A. You’ll need IV methadone to start
B. You will be able to take 1 week’s worth of methadone home at a time
C. You may take your methadone tablets at any time
D. You have to come here to the clinic to receive your dose of methadone

A

D

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59
Q

Methadone must be taken at the _______ daily

A

Clinic

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60
Q

A pts/ alcohol use d/o has verbalized a desire to stop drinking. The HCP has ordered disulfiram. What teaching is required?
A. Drinking even small amounts of alcohol will cause illness
B. It will prevent you from experiencing any effects of alcohol intake
C. Disulfiram will eliminate your cravings for alcohol
D.you should take the disulfiram promptly if you drink alcohol

A

A

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61
Q

How does disulfiram help patients to stop drinking alcohol?

A

Unpleasant effects of alcohol and disulfiram together- symptoms can be caused my drinking, cold medicines, mouthwash, or meds with alcohol in them

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62
Q

A pt has just been rx carbamazepine. What diagnosis in the pt/s med hx would concern the nurse the most?
A. Kidney dysfunction
B. Sinus bradycardia
C. Bone marrow suppression
D. SA block

A

C

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63
Q

Contraindication for carbamazepine

A

Bone marrow suppression; carbamazepine has a black box warning for blood dyscrasias

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64
Q

A pt is taking phenytoin for a seizure disorder. What adverse effect should the nurse review with the pt?
A.gingival hyperplasia
B. Dependence
C. Peripheral neuropathy
D. Diarrhea

A

A

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65
Q

Pts should be sure to visit their dentist _______ or more frequently if needed bc _________ can cause gingival hyperplasia

A

Biannually; phenytoin

66
Q

Which medication will interfere with the effectiveness of oral contraceptives?
A. Sumatriptan
B. Acetaminophen
C. Glimepride
D. Phenytoin

A

D

67
Q

Phenytoin decreases the effectiveness of _______ ________, so the pt will need to use a backup method

A

Oral contraceptives

68
Q

What pregnancy category is phenytoin?

A

D

69
Q

Carbamazepine is an

A

Anticonvulsant metabolized by the liver
Pregnancy category D
Therapeutic blood level is 4-12 mcg/mL
Black box warning: blood dyscrasias, HF, fluid overload

70
Q

Contraindications for carbamazepine

A

preexisting anemia, agranulocytosis, or liver disease

71
Q

Nursing considerations for carbamazepine

A

monitor CBC, serum drug level, SI. CNS changes, ECG, electrolytes. Lung sounds and edema, seizure prectations. LFT

72
Q

Pt teaching for carbamazepine

A

Similar to other antiseizure meds, report dyspnea, bruising, edema in dependent areas, or frequent infections, take before bed.

73
Q

Valproic acid is a

A

Broad spectrum anti epileptic drug and it is used to treat all type of seizures

74
Q

Mechanism of action for Valproic acid

A

Increases levels of GABA

75
Q

Therapeutic level for Valproic acid

A

50-150 mcg/mL

76
Q

T/F: Valproic acid is not highly protein bound

A

False- it is highly protein bound

77
Q

How is Valproic acid metabolized?

A

By the liver

78
Q

Side and adverse effects for Valproic acid

A

GI problems, hepatotoxicity, tremor, weight gain , elevated blood ammonia levels, pancreatitis, SI, or suicidality

79
Q

Pt teaching for Valproic acid

A

Similar to other antiseizure meds, can take with food

80
Q

Nursing considerations for Valproic acid

A

CBC, LFT, amylase and lipase, serum drug levels. S/S hepatotoxicity, SI

81
Q

Contraindications for Valproic acid

A

Those less than 2 years old
Highest risk

82
Q

Gabapentin is used as

A

An adjunct to treat partial seizures and postherpetic neuralgia

83
Q

Gabapentin mechanism of action

A

Promotes the release of GABA

84
Q

Side and adverse effects of Gabapentin

A

CNS effects. Children: viral infection, fever, N/V, somnolence, hostility

85
Q

Nursing considerations for Gabapentin

A

Assess of neuropsychiatric adverse effects, SI

86
Q

Pt teaching Gabapentin

A

Similar to other antiseizure meds

87
Q

Succinimides

A

Used to treat absence seizures

88
Q

Ethosuximide

A

Anticonvulsant, succinimide

89
Q

Therapeutic blood is 40-100mcg/mL for

A

Succinimides

90
Q

Therapeutic levels for succinimides

A

40-100mcg/mL

91
Q

Side and adverse effects of succinimides

A

Increased frequency of seizures, Stevens-Johnson syndrome, bone marrow suppression, drowsiness, dizziness, lethargy, N/V, SLE, impaired liver or renal function

92
Q

pt teaching for succinimides

A

Similar as other antiseizure medications, use correct measuring devices, can take with food

93
Q

Nursing considerations for succinimides

A

CBC, LFT, UA, serum drug levels

94
Q

Phenobarbitals are

A

Anticonvulsants, sedative-hypnotic/ barbiturates

95
Q

Mechanism of action for phenobarbital

A

General CNS depressant, stimulates GABA receptors
Not used as first line treatment
Induces hepatic enzyme system which alters metabolism of many other drugs

96
Q

Side and adverse effects of phenobarbital

A

CNS depression, drowsiness, laryngospams, angioedema, serum sickness, paradoxical effects. Short-term memory deficits in children. Status epilepticus. SI suicidality

97
Q

Nursing considerations for phenobarbital

A

VS, CBC, LFT, renal function

98
Q

Nursing considerations and pt teaching for anti-seizure medications in general

A

Monitor serum drug level
Avoid driving
Wear a medic alert ID
Do not abruptly stop
Keep a seizure log
Seizure precations
Hormonal contraceptives are ineffective-barrier
Most are pregnancy category D
Avoid CNS depressants (alcohol)
Avoid grapefruit juice
Monitor for skin rash
Most cause dizziness and drowsiness

99
Q

how do you score a patient for dosing a benzodiazepine

A

VS and assessment data ,adjust dose every 2hours

100
Q

nonpharmacologic interventions for Parkinson’s Disease

A

increase exercise, fiber, fluids; support group therapy

101
Q

Carbidopa-Levodopa is a drug for

A

Parkinson’s disease

102
Q

levodopa is a

A

metabolic precursor of dopamine that crosses the blood-brain barrier; dopamine agonist, anti-Parkinson agent

103
Q

Carbidopa is a

A

dopamine decarboxylase inhibitor that does not cross the blood-brain barrier

104
Q

how does carbidopa work with levodopa

A

reduces peripheral metabolism of levodopa to increase the amount of levodopa reaches brain; more delivered to CNS in lower doses with carbidopa

105
Q

contraindications for Carbidopa-Levodopa

A

hypersensitivity, melanoma, closed-angle glaucoma, MAOIs, severe cardiac disease, renal or hepatic disease, dyskinesia, pulmonary disease

106
Q

side effects for carbidopa-levodopa

A

N/V, anticholinergic effects, dyskinesia (at high doses), sweat and urine may turn red, brown, or black(expected)

107
Q

adverse effects of carbidopa-levodopa

A

orthostatic hypotension, angioedema, palpitations, psychosis, depression, SI, agranulocytosis, dysrhythmias, neuroleptic malignant syndrome (if stopped abruptly)

108
Q

pt teaching for carbidopa-levodopa

A

do not stop taking abruptly, eat food after taking it ad avoid high protein (decreases absorption), change positions slowly, avoid activities requiring alertness, good oral hygiene, avoid multivitamins involving iron and B6 (pyroxamine)-> decrease med effectiveness, darkening of urine is ok, notify HCP of a/e, increase fiber, fluids, exercise, on/off syndrome, risk for injury/falls

109
Q

what is on/off syndrome?

A

med wears off and dopamine levels become low between doses=Parkinson’s s/s

110
Q

what a/e should a pt report to HCP for carbidopa-levodopa

A

palpitations, urinary retention, involuntary movmts, behavioral changes, severe N/V, new skin lesions

111
Q

interventions for cardbidopa-levodopa

A

monitor VS, I&O, assess and treat constipation, monitor LFT and RFT, monitor for toxicity and agranulocytosis (CBC with diff)

112
Q

s/s of carbidopa-levodopa toxicity

A

involuntary muscle twitching, facial grimacing, spasmodic eye winking, exaggerated protrusion of tongue and behavioral changes

113
Q

Ripinirole is a

A

dopamine agonist/anti-Parkinson agent used for management in monotherapy or adjunctive therapy with carbidopa-levodopa; also tx for restless leg syndrome

114
Q

side and adverse effects of ripinirole

A

sudden inability to stay awake, daytime sleepiness, orthostatic hypotension, psychosis, impulse control disorder, dyskinesia, nausea

115
Q

interventions and teaching for ropinirole

A

take as directed, report drowsiness/daytime sleepiness
avoid CNS depressants
change positions slowly
use good oral hygiene (dry mouth= gum and candies)
report hallucinations and/or nightmares
report uncontrollable urges (i.e. gamble)

116
Q

Benztropine is a

A

anticholinergic/ anti-Parkinson agent used for adjunctive tx for all forms of Parkinson’s disease

117
Q

mechanism of action for benztropine

A

blocks cholinergic action in the CNS

118
Q

Benztropine is used to trat

A

all forms of Parkinson’s disease including drug induced extrapyramidal effects nd acute dystonic rxn

119
Q

side and adverse effects for benztropine

A

N/V, anticholinergic effects, antihistamine effects(sedation)

120
Q

pt teaching for benztropine

A

take with food, inc fiber fluid and exercise , report urinary retention, oral hygiene, avoid CNS depressants, avoid activities that require alertnessn

121
Q

nursing considerations for benztropine

A

avoid giving to older adults (BEER’s criteria), monitor I&O (constipation and urinary retention)

122
Q

what are the Parkinson’s disease drugs

A

Carbidopa-Levodopa,Ropinirole,Benztropine,

123
Q

drug for Alzheimer’s disease

A

Donepezil

124
Q

Donepezil is a

A

anti-Alzheimer agent/cholinergic, Acetylcholinesterase enzyme inhibitors aka reversible cholinesterase inhibitor

125
Q

Donepezil is used to treat

A

mild-to - moderate dementia associated with Alzheimer’s disease

126
Q

mechanism of action for donepezil

A

improves cholinergic function, prevent cholinesterase from inactivating acetylcholine

127
Q

side and adverse effects of donepezil

A

excessive muscarinic stimulation, increased respiratory secretions, cholinergic crisis, peptic ulcers SLUDGES

128
Q

what is cholinergic crisis treated with?

A

atropine

129
Q

pt teaching for donepezil

A

report s/s GI bleed, report s/s cholinergic crisis. Does not cure Alzheimer disease, take before bed

130
Q

nursing considerations for donepezil

A

assess for improvement in cognitive function. crash cart in case of cholinergic crisis and ventilation may be needed

131
Q

neostigmine is a drug for

A

myasthenia gravis; can diagnose MG and reverse neuromuscular blockade

132
Q

mechanism of action for neostigmine

A

indirect acting cholinergic agonists, reversible cholinesterase inhibitor

133
Q

contraindications for neostigmine

A

GI obstruction, ileus, urinary tract obstruction, peritonitis

134
Q

use neostigmine cautiously in those with

A

peptic ulcer disease, hypothyroidism, seizure disorder and those with hypotension and bradycardia

135
Q

side and adverse effects for neostigmine

A

excessive muscarinic stimulation (increase secretions, GI motility, diaphoresis, salivation, urinary urgency, cholinergic crisis (biggest adverse effect)

136
Q

cholinergic crisis S/S

A

respiratory depression and paralysis of respiratory muscles; increase GI motility, bradycardia, muscle constriction, pupillary constriction, increased sweating and salivation

137
Q

what do you treat cholinergic crisis with

A

atropine

138
Q

myasthenic crisis

A

muscle weakness that becomes pronounced and can lead to quadriparesis, quadriplegia, SOB, respiratory insufficiency and difficulty swallowing

139
Q

myasthenic crisis is a result of

A

undermedication

140
Q

cholinergic crisis is a result of

A

overmedication

141
Q

nursing considerations for neostigmine

A

antidote is atropine
cholinergic crisis–> crash cart and mechanical ventilation
bedpan/urinal–> sphincter control decreases bc of cholinergic
teach s/s of over/under medication

142
Q

what can you administer to determine whether it is myasthenic or cholinergic crisis

A

edrophonium (a cholinergic) via IV
if s/s worsens, pt needs antidote (atropine)
if s/s improve, pt needs more cholinergic (myasthenic crisis)

143
Q

drugs for muscle spasms are also classified as

A

central-acting muscle relaxants because they affect the CNS

144
Q

examples of central-acting muscle relaxant drugs

A

baclofen
dantrolene
cyclobenzaprine

145
Q

central-acting muscle relaxants cause

A

decrease in pain, increased ROM, dependence (DO NOT ABRUPTLY STOP)

146
Q

side and adverse effects of muscle relaxants

A

CNS depression

147
Q

dantrolene has an adverse effect of

A

hepatotoxicity

148
Q

central-acting muscle relaxants can cause

A

drowsiness, sedation, dizzinessn

149
Q

nursing interventions for muscle spasm drugs

A

monitor VS, dizziness, lightheadedness, avoid driving and CNS depressants, monitor LFT, monitor for constipation and urinary retention, take with food, increase fiber and fluids

150
Q

why can a pt not directly stop central-acting muscle relaxers?

A

rebound spasms, hallucinations, seizures

151
Q

Neuromuscular blocking drug

A

succinylcholine(depolarizing)

152
Q

what does succinylcholine do?

A

mimics Acetylcholine preventing it from binding with its receptors

153
Q

succinylcholine is

A

a short-acting paralytic

154
Q

fun fact about succinylcholine

A

only depolarizing agent in the United States

155
Q

antidote for succinylcholine

A

neostigmine

156
Q

what is succinycholine used for

A

emergent ventilation and intubation

157
Q

if given IV succinylcholine

A

causes complete muscle relaxation in 30 sec- 1 min for 2-3 min

158
Q

Non-depolarizing neuromuscular blocking drugs

A

pancuronium and vancuronium (adjunct to general anesthesia)

159
Q

side/adverse effects for neuromuscular blocking drugs

A

respiratory arrest(paralyzed resp muscles)
muscle pain (12-24 hrs after d/c)
malignant hyperthermia
hyperkalemia

160
Q

malignant hyperthermia

A

stop med, oxygen at 100%, decrease body temp, administer dantrolene

161
Q

T/F: neuromuscular blocking drugs DO NOT affect hearing, thinking, or the ability to feel pain

A

true

162
Q
A

Pharmacology (12 decks)

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